key: cord-0954250-gl5lk3ml authors: Sharma, Meenakshi; Sharma, Charu; Mandal, Sisir Kumar; Nesari, Tanuja Manoj; Kumar, Anil title: Immune status determined as per guidelines of Ayurveda found associated with clinical outcomes of COVID-19 disease – Results of a cross-sectional pilot study date: 2021-05-24 journal: J Ayurveda Integr Med DOI: 10.1016/j.jaim.2021.03.007 sha: e680678bc853a2bb32f57272fda08b2c9d5c88f9 doc_id: 954250 cord_uid: gl5lk3ml BACKGROUND: A key public health priority during the emergence of a novel pathogen is probing the factors contributing in clinical severity of the disease COVID-19. Moreover, analysis of the determined clinical outcomes is required and thus, modifiable predictor values need to identified. In Ayurveda, outcome of a disease is a multivariate function and this exploratory work is an attempt to identify one such factor “ Vyadhiksamatwa ” (immune status). MATERIALS AND METHODS: A questionnaire-based, cross-sectional study was conducted in fifty diagnosed cases of COVID–19. Study participants were subjected to a questionnaire to assess relationship between the three determinants of the disease - exposure, clinical severity and Vyadhiksamatwa (immune status) RESULTS: Clinical Severity was found strongly correlated with Vyadhiksmatwa (with the value of Pearson Correlation - 0.740 significant at the 0.01 level (2-tailed). CONCLUSION: In the determination of clinical severity of disease, there are two epidemiological factors responsible – extrinsic (exposure) and intrinsic (Vyadhiksamatwa). It has been observed that higher the value of Vyadhiksamatwa of an individual lesser will be the clinical severity of the disease in that individual. Vyadhiksamatwa can alter the host response to infections. , caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 27 2), as a Public Health Emergency of International Concern. [1] The disease is spreading globally 28 despite of multiple efforts done worldwide to contain it. [2] Initially, clinical severity of COVID- 29 19 disease was categorized under mild, moderate and severe illness. But, with the global 30 outbreak, asymptomatic category is also observed that has no symptoms but can transmit the 31 J o u r n a l P r e -p r o o f virus to others. [3] The percentage of asymptomatic infection in an electronic meta analysis was 1 found to be 15.6% (95%CI, 10.1%-23.0). [4] There is variable presentation of the disease among 2 different age groups and serious manifestations can be commonly observed in immune 3 compromised, old aged and comorbid conditions and less severe in pediatric age group, implying 4 the role of immunity in pathogenesis of COVID-19. [5] [6] [7] Studies revealed that immune system 5 plays a crucial role in response to SARS-CoV-2 with significant difference among severe and 6 non-severe patients. [8] The outcome of clinical infection majorly depends on the capacity in 7 mounting effective antiviral immune responses of an individual in time, so as to control viral 8 spread, preventing multiple organ injuries and speed up recovery from infection. [9] Therefore, it 9 is necessary to understand basic pathological and immunological process responsible of 10 COVID--19 for formulating the therapeutic guidelines on rational basis. [10] In Ayurveda, the 11 concept of Vikaravighatabhava (disease inhibiting factors) and Vikaravighatabhavaabhava 12 (absence of disease inhibiting factors) determines the manifestation and progression of the 13 disease. Based on the amalgamation of the three factors (Nidana, Dosha, Dushya) as well as 14 Vyadhiksamatwa Bala (immunity) of an individual, the progression of disease can be 15 mapped. [11, Nidana Sthana ; Prameha Nidana, Chapter 4/4] Acharya Charka has mentioned that 16 even unwholesome food does not produce disease in all individuals, suggesting that one's 17 immune system is instrumental in manifestation of disease. This can be implicated further as 18 Vyadhibalavirodhitwa(resistance against disease) and Vyadhyutpadaka Pratibandhakatwa 19 (resistance against agents causing the disease). [ time required to complete the survey questionnaire was informed to them. The patients were 28 interviewed through questionaries via telephonic conversation. 29 (IPC) during interactions, following social-distancing norms and following government 14 guidelines. Direct/indirect contact history include residential factor , occupation travel history 15 and mass gatherings. Data from Arogya Setu app was also incorporated (an application that 16 notifies the users if they are in vicinity of a diagnosed positive patient. [15] Clinical severity of 17 the illness was assessed, based on the grading system of symptoms. [16] Vyadhiksamatwa factor 18 was assessed through factors stated as above in introduction.Though there are varying definitions 19 of Vyadhiksamatwa but the purpose of the study to understand the dynamic nature of this factor. 20 Thus, this aspect was selected as it also had a rational value in applied science. Exposure to an 21 exogenous entity can be considered virudhha ahara (incompatible food). This type antagonism 22 reaction is neutralized through Vyadhiksamatwa. This is further a function of suitability to that 23 antigen , exposure in small quantity/ mild exposure , strong digestive power, age dependent , 24 and in persons having unction, physical exercise, and strength. The exogenous factor i.e. 25 exposure was already assessed , so as to avoid repetition only unwholesome dietary part was 26 considered and thus enquired. All the items were scored on the scale of frequency. 27 The questionnaire was administered on the very same day when the patient was diagnosed with 29 COVID illness so as to mitigate the effect of amnesic bias. This study was approved by the institutional review boards of All India Institute of Ayurveda, 7 New Delhi. Permission from institutional Ethics Committee was obtained (IEC-AIIA/2020-P 48) 8 and Clinical Trial Registry was done ( CTRI/2020/08/027494). A written informed consent was 9 obtained from the participants on the day of testing. 18 Mean value of this variable was found to be 17.52. Exposure score was calculated through 20 measuring factors such as host behavior (Personal hygiene practices), contact history, social 21 distancing, population density and ventilation. Each of the variable was scored between 0 (Nil) to 22 3 (Severe) .76% of them were localized in urban area. 8% of them were health workers 23 performing regular duties and 62% were non-health workers, not going out for regular duties. 20% of the population was residing in an area of high-room density (more than 2). 54% of the 25 infected persons had visited a high-risk area within a span of 1 to 6 days. 8% of the population 26 had a close contact history i.e. more than 20 COVID infected individuals were within their 27 circumference of 500 meter. 72% of them were maintaining personal hygiene most of the times 28 and 84% of them were regularly wearing mask. Social distancing was maintained properly by 29 only 70% of them. 44% of them had poor ventilation in their houses. Only 6 of them were 3 During the emergence of a completely novel pathogen, the most critical health question pertains 4 to the spectrum of illness presentation or severity profile. The mean value of clinical score was 5 found 5.3. It was determined through gradations of symptoms. 18% of them were asymptomatic. 6 Among the symptomatic ones, the most common presenting complaint was fever (56% ) , 7 followed by cough (52%). Only 1 % of them had nausea and vomiting ,4 % of the patients had 8 breathing difficulty ,9 % had the complaint of headache. Anosmia was present on 12% of the 9 population, dysgeusia in 14 %. 13 The mean value for this variable was found to be 14 An urgent need for effective therapeutics in matters of public health concern, require a gross can be constitutional, temporal or even acquired. [18] The study deals with the application of a 4 descriptive model of pathogenesis mentioned in Ayurveda "Vikrati vighata bhava abhava" 5 Based on the research model , stratification of exposed population can be done on the basis of occupational history, living conditions and contact history. Exposure score was above the median 10 value in health care workers and patients who lived in urban areas and higher room density 11 (indicator of overcrowding).This is further supported by a study conducted in the UK and the 12 USA which reported that the risk of reporting a positive test for COVID-19 was increased among 13 front-line health-care workers. [18] Impact of room-density has also been investigated in this 14 respect and the relationship between urban area and COVID-19 virus has been observed. [19] 15 Host behavior and number of contacts is also one of the contributing factors [20] . Since the 16 pandemic can be spread by aerosol transmission from person to person, with direct or indirect 17 contact [21] . Social distancing is a type of non-pharmaceutical countermeasures (NPCs). The 18 intervention is aimed to minimize physical contact between individuals and thereby reducing the 19 possibility for new infections [22] .Age is another important factor that determines the clinical 20 severity as it has been reported that the disease is more fatal in older patients. [23] Closed areas 21 with low airflow and ventilation increase the risk of COVID 19 infection. [24] The relationship 22 between high population density and spread of epidemics has been reported in earlier 23 researches. [23] Personal hygiene practices such as hand sanitization are mandatory to limit the 24 community spread of viral diseases, especially SARS-CoV-2. [24] 25 The determination of variable was done based on all these variables. Chapter 7/32] Old ages compromise immunity and self-defense making them more vulnerable to 20 infectious diseases and acute respiratory distress syndrome but also more likely to have health 21 conditions such as coronary, lung or kidney diseases, diabetes which can contribute to their low 22 immunity levels. This pilot study was a basic attempt to assess the role of a host factor responsible in progression • Ventillation associated event (VAE) • Housing (Room density) • Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in wuhan, China: a descriptive study Epidemiological data from the covid-19 outbreak, real-time case information National Health Commission of People's Republic of China. 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The Journal of research and education in Indian medicine Fatigue in cancer patients receiving chemotherapy: an analysis of published studies CharakaSamhita of Agnivesha, Vimana Sthana.chapter 8, verse 122 CharakaSamhita of Agnivesha, Sutra Sthana.chapter 26 CharakaSamhita of Agnivesha, Sutra Sthana.chapter 26 Sushruta Samhita of Sushruta Varanasi: ChaukhambhaOrientalia CharakaSamhita of Agnivesha, Sutra Sthana: Ashtauninditiyadhyaya, chapter 21 Abhayavaharana Shakti-Power of ingestion -Capacity of food intake Agni -All factors responsible for digestion and metabolism / transformation Bala-Energy required to perform daily activities is Strength Bala vridhikara bhava-Factors responsible for increasing strength Jaranshakti-Individual capacity to digest the consumed food Kapha-One of the three bodily Doṣas responsible for stability, unctousness, lubrication, immunity, and cohesion Oja-The essence of all seven Dhātus, that is vital for life and an indicator of Bala (immunity) Rakta dhatu-The second Dhātu (body tissue) among seven Dhātus whose function is Jīvana (to give life). It is formed in Yakṛt (liver) and Plīhā (spleen) with the help of Raṅjaka Pitta and Rakta Dhātvagni Satyma-Agreeable to natural constitution, wholesome, suitableness, habituation Snigdha-Slimy/unctuous/oily; denotes physiological & pharmacological sliminess; manifested by moistening of body parts, increased strength and lustier; pacifies vata Vayu-One of the three bodily Doṣas, a vital biological force that performs the fuctions like all sensory perceptions, all motor activities, and higher mental activities 14) Vikaravighatabhava-Factors that inhibit disease They do not help in the nourishment of Dhātu and in due course produce many diseases/incompatible food. Food which are antagonist to body and Dhātu are called as Viruddha 16) Vyadhiksamatwa-The power of the body which prevents the development of diseases or resists a Vyadhipratibandhaktwam-Resistance against agents causing disease Vyadhibalavirodhitwama-Resistance against disease Vyayama shakti-Exercise; The act or movement of the body that causes fatigue. Etymologically the meaning vyāyāma is intensive development of self control of Yuktikrit bala-Strenght achieved from exercise or food Please check the following as appropriate:All authors have participated in (a) conception and design, or analysis and interpretation of the data; (b) drafting the article or revising it critically for important intellectual content; and (c) approval of the final version.This manuscript has not been submitted to, nor is under review at, another journal or other publishing venue.The authors have no affiliation with any organization with a direct or indirect financial interest in the subject matter discussed in the manuscript